COST-EFFECTIVENESS ANALYSIS OF SCREENING HEALTH-CARE WORKERS FOR HIV

Background. Because of the public's concern regarding the possibility of human immunodeficiency virus (HIV) transmission from health care worker to patient, this study evaluated the cost-effectiveness of screening health care workers for HIV. Methods. The study examined a screening protocol that would include a sequence of antibody tests (enzyme-linked immunosorbent assay and the Western blot) and culture for HIV. The incremental cost-effectiveness of applying this protocol as opposed to the status quo for the prevention of transmission of HIV from health care worker to patient was evaluated. Sensitivity analysis was performed on appropriate variables. The incremental cost-effectiveness ratio was then compared with that of other interventions. Results. The expected annual cost of screening to a large hospital was found to be $244,382 to prevent 0.02663 transmissions. The incremental cost-effectiveness ratio was $9,177,615 per transmission prevented. Sensitivity analysis revealed that the incremental cost-effectiveness ratio is relatively insensitive to the variability in the performance characteristics of the individual tests but highly sensitive to variance in HIV prevalence, estimated risk of transmission, and the number of exposure-prone procedures performed annually. Cost-effectiveness ratios ranged from $917,762 to $91,776,156 per transmission prevented. Conclusions. Screening health care workers for prevention of potential HIV transmission to patients is an expensive use of health care resources.